Cost-Effectiveness Analysis of Amino Acid PET–Guided Surgery for Supratentorial High-Grade Gliomas

Abstract

High-grade gliomas are brain tumors associated with a devastating prognosis. Recent studies have indicated that the combined use of amino acid PET and MRI is superior to MRI alone to plan the surgical resection of high-grade gliomas. The aim of the study was to analyze the cost-effectiveness of the use of amino acid PET for the surgical resection of high-grade gliomas, compared with MRI alone, from the perspective of the national health insurance in Germany. Methods: A decision-tree model was set up to compare 2 strategies: the use of MRI alone and the combined use of MRI and PET for surgical resection of high-grade gliomas. For the analysis, 2 scenarios were calculated: a baseline scenario and a more expensive scenario, accounting for disease severity. To test the robustness of the results, probabilistic sensitivity analyses using Monte Carlo simulation were calculated. Results: Compared with MRI alone, the combined use of MRI and PET showed an incremental cost-effectiveness ratio of €2,948 (€1~U.S.$1.3)per life-year gained for the baseline scenario and an incremental cost-effectiveness ratio of €4,105 per life-year gained for the admissible-charge-rate scenario. In the probabilistic sensitivity analysis in about 60% of the iterations, the combined use of PET and MRI was superior to MRI alone when assuming a willingness-to-pay threshold of €30,000. Conclusion: The model indicates that the combined use of MRI and PET may be cost-effective. The results of this analysis have to be considered carefully because there was only limited empiric evidence for several input parameters.

The Use of O-(2-18F-Fluoroethyl)-l-Tyrosine PET for Treatment Management of Bevacizumab and Irinotecan in Patients with Recurrent High-Grade Glioma: A Cost-Effectiveness Analysis

“…Moreover, our results are also in line with other cost-effectiveness analyses evaluating the use of amino acid PET in patients with newly diagnosed gliomas (23,27). The results of these studies suggested that amino acid PET might be cost-effective for planning the surgical resection of rHGG and for selecting the biopsy site for newly diagnosed brain tumors.…”

“…For the attribution of probability distributions to the variables of the decision tree, triangular distributions were used (23,(26)(27)(28). On the basis of the initial definition of the intervals by the experts, we fitted the respective distributions for all variables (Table 2).…”

Cost-effectiveness of 99mTc-MIBI in the evaluation of thyroid nodules for malignancy: a new lease of life for an old radiopharmaceutical?

“…Models such as the one presented by the authors are important tools to summarize the available data and, based on this, to draw conclusions on the medical effectiveness and cost-effectiveness of the procedure in question. This has already been performed for several other nuclear medicine procedures [16][17][18]. Wale et al deliver additional information that goes well beyond the known literature.…”

Diagnostic accuracy of F-18-fluoroethyltyrosine PET and PET/CT in patients with brain tumor

“…The inclusion of more true negative cases would also help to better determine the specificity, although this could be difficult, as patients may not necessarily undergo biopsy if FET-PET is negative. Finally, although cost-effectiveness of FET-PET in the management of patients with brain tumor has recently been studied, the results obtained should be treated with caution due to several limitations of the reported model [45,46]. Thus, there is still a need for cost-effectiveness studies of FET-PET, used separately or in combination with MRI, in the clinical setting.…”